Part B Therapy · Estimator
Part B Visit Estimator
Estimate what a single date of service pays under Medicare Part B: enter the day's therapy lines and the page applies MPPR and the PTA/OTA differential to show the allowed amount.
Data statusEstimator
- Status
- Estimator
- Data year / effective
- CY2026
- Last reviewed
- June 2026
- Last updated
- June 2026
- Known exclusions
- GPCI / locality and MPPR/sequestration vary
- Medical-necessity and KX rules apply
- Validate against the MPFS and your MAC
Estimate only — wage index, sequestration, and payer/MAC edits are not applied. Validate against CMS and your MAC before billing.
CPT code
Allowed / unit ($)
PE portion (%)
Units
Adjustments
Before adjustments
$0
Estimated allowed
$0
Chains the rules in order: MPPR first (50% PE reduction on every unit after the highest-PE unit), then the PTA/OTA 85% differential if checked. The work and malpractice portions are never reduced.
An estimate only — uses the amounts and PE shares you enter. Confirm against the current MPFS and your MAC. CPT codes are AMA-copyrighted and referenced by number.
This sizes one visit. To accumulate visits toward the annual cap, use the KX Threshold Tracker. See also the MPPR Calculator and Billing Units.
